DIAGNOSTIC ACCURACY OF RAPID FOSFOMYCIN NP TEST FOR DETECTION OF FOSFOMYCIN RESISTANCE IN ESCHERICHIA COLI IN A TERTIARY CARE HOSPITAL IN PAKISTAN

Authors

  • Faryal Yunus Armed Forces Institute of Pathology, Rawalpindi-Pakistan
  • Ashfaq Hussain Pakistan Navy Ship Shifa Hospital, Karachi-Pakistan
  • Irfan Ali Mirza Armed Forces Institute of Pathology, Rawalpindi-Pakistan
  • Faisal Hanif Pakistan Navy Ship Shifa Hospital, Karachi-Pakistan
  • Wajid Hussain Armed Forces Institute of Pathology, Rawalpindi-Pakistan
  • Luqman Satti Pakistan Navy Ship Shifa Hospital, Karachi-Pakistan
  • Umar Khursheed Armed Forces Institute of Pathology, Rawalpindi-Pakistan

Keywords:

Urinary tract infections (UTIs), Rapid Fosfomycin Nordmann Poirel (NP) test, Escherichia coli (E.coli)

Abstract

Background: Emergence of resistance among Escherichia coli (E.coli) isolates against therapeutic options for UTIs (Urinary tract infections) has led to renewed interest in older antibiotics like Fosfomycin. In this study we evaluated diagnostic accuracy of Rapid Fosfomycin NP test based on glucose metabolism for rapid Fosfomycin susceptibility testing among urinary E.coli isolates. Methods: In a cross-sectional validation study conducted in the Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from 15th March to 15th September 2020, 149 consecutive urine specimens were included as per selection criteria. Rapid Fosfomycin NP test was performed as per protocol of Nordmann P et al on urinary E.coli isolates for detection of Fosfomycin resistance and results were compared with reference modified Kirby-Bauer disk diffusion method. Results: Out of total 149 E.coli isolates from 149 urine specimens, 80 were classified as Fosfomycin susceptible and 69 as Fosfomycin resistant by reference disk diffusion method. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of rapid Fosfomycin NP test was found to be 94.2%, 98.75%, 98.48%, 95.2% and 96.64%, respectively. In our study reliable results were achieved after 2.5 hours of incubation. Conclusion: The rapid Fosfomycin NP test is valid and user-friendly technique which can be performed with minimal technical expertise. It is less time consuming than disk diffusion and E-test strips and easy to perform as compared to agar dilution method. It can be useful as alternative to agar dilution in urinary E.coli isolates which would help in selecting appropriate therapeutic option for UTIs.

References

Anjum MU, Khan MS, Shahid AR, Shah SH. Urinary tract infections; etiological profile and antimicrobial susceptibility patterns of uropathogens. Professional Med J 2016;23(1):10–14.

Flores-Mireles A, Hreha TN, Hunstad DA. Pathophysiology, Treatment, and Prevention of Catheter-Associated Urinary Tract Infection. Top Spinal Cord Inj Rehabil 2019;25(3):228–40.

Steiger SN, Comito RR, Nicolau DP. Clinical and economic implications of urinary tract infections. Expert Rev Pharmacoecon Outcomes Res 2017;17(4):377–83.

McLellan LK, Hunstad DA. Urinary tract infection: pathogenesis and outlook. Trend Mol Med 2016;22(11):946–57.

Cortes-Penfield NW, Trautner BW, Jump RL. Urinary tract infection and asymptomatic bacteriuria in older adults. Infect Dis Clin North Am 2017;31(4):673–88.

Vásquez V, Ampuero D, Padilla B. Urinary tract infections in inpatients: that challenge. Rev Esp Quimioter 2017;30(Suppl 1):39–41.

Khan IU, Mirza IA, Ikram A, Ali S, Hussain A, Ghafoor T. In vitro activity of fosfomycin tromethamine against extended spectrum beta-lactamase producing urinary tract bacteria. J Coll Physicians Surg Pak 2014;24(12):914–7.

Silver LL. Fosfomycin: mechanism and resistance. Cold Spring Harb Perspect Med 2017;7(2):a025262.

Nordmann P, Poirel L, Mueller L. Rapid Detection of Fosfomycin Resistance in Escherichia coli. J Clin Microbiol 2019;57(1):e01531.

Zhanel GG, Walkty AJ, Karlowsky JA. Fosfomycin: A First-Line Oral Therapy for Acute Uncomplicated Cystitis. Can J Infect Dis Med Microbiol 2016;2016:20826937.

Sastry S, Doi Y. Fosfomycin: resurgence of an old companion. J Infect Chemother 2016;22(5):273–80.

Díez-Aguilar M, Cantón R. New microbiological aspects of fosfomycin. Rev Esp Quimioter 2019;32(Suppl 1):8.

Mojica MF, De La Cadena E, Hernández-Gómez C, Correa A, Appel TM, Pallares CJ, et al. Performance of disk diffusion and broth microdilution for fosfomycin susceptibility testing of multi-drug resistant clinical isolates of Enterobacterales and Pseudomonas aeruginosa. J Glob Antimicrob Resist 2020;21:391–5.

Weinstein MP, Patel JB, Bobenchik AM, Campeau S, Cullen SK, Galas MF, et al. M100 Performance Standards for Antimicrobial Susceptibility Testing A CLSI supplement for global application. 2020.

European Committee on Antimicrobial Susceptibility Testing. European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters, Version 10.0. 2020.

Nordmann P, Poirel L, Dortet L. Rapid detection of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2012;18(9):1503.

Nordmann P, Jayol A, Poirel L. Rapid detection of polymyxin resistance in Enterobacteriaceae. Emerg Infect Dis 2016;22(6):1038–43.

Clinical and Laboratory Standards Institute. Method for dilution antimicrobial susceptibility tests for bacteria that grow aerobically 11th ed. Document M07.CLSI, Wayne, PA. 2018.

Dalmolin TV, Dias GÁ, de Castro LP, Ávila H, Magagnin CM, Zavascki AP, et al. Detection of Enterobacterales resistant to polymyxins using Rapid Polymyxins NP test. Braz J Microbiol 2019;50(2):425–8.

Malli E, Florou Z, Tsilipounidaki K, Voulgaridi I, Stefos A, Xitsas S, et al. Evaluation of rapid polymyxin NP test to detect colistin-resistant Klebsiella pneumoniae isolated in a tertiary Greek hospital. J Microbiol Methods 2018;153:35–9.

Shoaib M, Hussain A, Satti L, Hussain W, Zaman G, Hanif F. Evaluation of rapid polymyxin Nordmann Poirel test for detection of polymyxin resistance in clinical isolates of Enterobacteriaceae. Eur J Clin Microbiol Infect Dis 2020;39(11):2195–8.

Published

2021-09-22

Issue

Vol. 33 No. 4 (2021): Journal of Ayub Medical College Abbottabad

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.

Most read articles by the same author(s)